As chief medical officer of Elite Care, a freestanding emergency center with facilities in San Antonio and across the state, I would like to address some of the assertions made about emergency care in a recent Viewpoints column, "Freestanding emergency rooms threaten health of Texas business," by a representative of the Texas Association of Business.

All emergency rooms see low acuity patients - lots of them. This is because patients are not doctors, so the determination of whether symptoms are emergent or non-emergent can only be made after seeing a doctor. For this reason, the prudent layperson standard was created.

The prudent layperson standard protects Texans from high medical costs that arise from emergency situations, allowing them to be charged at in-network rates. Under this standard, health plans are required to pay for emergency visits for medical situations in which the average person believes his or her health is threatened. The final diagnosis should not influence whether the insurer pays for the emergency room visit, and insurers cannot legally apply the claim toward the out-of-network benefits.

However, insurance companies have been reluctant to apply this standard for care issued at FECs. By not providing usual and customary reimbursement rates, insurance providers violate the intent of the medical community and legislators who turned the prudent layperson standard into law.

In the TAB op-ed, the author argues that FECs drive up health care costs by remaining out of network. But the prudent layperson standard renders that point moot. Not only that, it brings to light the illegal practices of insurance companies processing emergency claims at the out-of-network rate.

Additionally, primary care physicians and urgent care facilities are usually not open after hours, on weekends or on holidays. ERs are frequently the only option for care available to patients needing immediate medical attention. While ERs do treat low acuity patients, this practice is not specific to FECs.

In fact, it is irresponsible to compare FECs to urgent cares and primary care physicians at all because they have vastly different capabilities. These FEC alternatives are not required to be open 24/7/365, do not have board-certified physicians on-site, and do not have CAT Scan, ultrasound or lab equipment to diagnose and treat high acuity patients.

FECs have the same capabilities as hospital-based ERs, and their prices are comparable. Since, by law, FECs and hospital ERs are identically reimbursed by insurance, the assertion that FECs engage in price gouging is both inflammatory and inaccurate.

The FEC industry employs more than 10,000 Texans and contributes roughly $40 million in taxes and fees to the State of Texas and to local governments. It is surprising and disappointing that TAB - an organization whose stated mission is "to make the Texas business climate the best in the world" - would choose to pick a fight with a flourishing new industry that generates so many jobs and so much revenue for the state.

In 2016, FECs provided more than $44 million in free emergency care administered to Medicare, Medicaid, and Tricare patients. FECs produce a net positive to Centers for Medicare and Medicaid Services, helping the state of Texas manage healthcare expenditures and balance its budget.

The growth of the FEC industry is not harmful to the business landscape in Texas. Quite the opposite is true. I encourage TAB to support this growing industry, as it will certainly have a positive impact on Texas' economy for the foreseeable future.

Dr. James Grueskin, MD, is the medical director at Elite Care's freestanding emergency center in San Antonio and chief medical officer of Elite Care 24-Hour Emergency Centers in Texas. He may be emailed at [email protected].

View the original story here.